Month: April 2012

I am a female (57) with receding and thinning hairline and temples (not as shown in the female balding diagrams), and just now reading about the FU HT alternative and would like to know:

1. Do both FU & Strip procedures require general anesthetic?
2. What would be the approx size of the donor area, needing to be shaved for the FU HT?
3. What is the difference in per graft costs, as I’m seeing wide variations ranging from $2.25 to $8
4. Do the FU grafts also fall out following the surgery and regrow as with the Strip method?
5. Transplants are advertised by several companies on TV as being permanent, but I’m reading in blogs etc that many patients appear to be requiring 3 or more procedures (along with lots of horrendous “gone wrong” outcomes from well known companies leading the field in HT which is very unsettling. Once started, is this an ongoing procedure and if so, how often might it be required to maintain the same thickness?

Thank-you

To clarify, I assume when you refer to “FU”, you’re actually asking about “FUE”. Follicular unit extraction (FUE) and the strip method are the 2 techniques used to harvest donor hair for transplantation.

1. All hair transplant surgeries are done with local anesthesia (much like when you see a dentist). You are not put to sleep.

2. Shaving the donor area is not necessary for regular hair transplant surgery. If individual hairs are extracted one by one, the back of the head would have to be shaved. This method is known as follicular unit extraction (FUE). FUE donor hair harvesting is usually performed with a 1mm cylindrical punch. The other method is often referred to as “strip” surgery, where a strip of scalp is removed from the back of the scalp. Both FUE and strip surgery fall under follicular unit transplantation (FUT), a generalized term of doing hair transplant surgery one follicular unit at a time. Strip surgery does not require shaving the head, but it will leave a linear scar that will be covered and unseen if you keep your hair long. FUE surgery will leave thousands of white 1mm dots that would be visible if you shave your head completely. Some men who cut their hair really short (less than 1 inch) sometimes prefer to have the FUE since the dots will not be seen. Most women choose the strip surgery over the FUE surgery.

3. The difference in graft cost you see on the Internet is similar to the difference in any cosmetic surgery cost. Not all surgery results and reputations of clinics and doctors are the same.

4. All the hairs or follicular units transplanted will fall out within the first month or so. The follicles will go through a dormant phase and start to produce a new hair shaft after several months. So the results of the surgery will not be evident for several months. 6 to 12 months is a general time frame we tell our patients.

5. The transplanted hairs are permanent, but it may not be enough if you are continuing to lose your existing hair. Some also have higher expectation and desire more fullness after their initial surgery. So there are patients who have more than one surgery to achieve their specific/individual goals. With respect to horror stories you read about and surgeries that go wrong, it is directly tied to your question number 3. It is up to you to do the research, as this is a cosmetic procedure and not like buying a commodity or buying a car. Not all hair transplants are equal.

This is a question asked in reference to our post from earlier this week, Do Bald Guys Have a Full Head of Hair That Just Won’t Grow?:

So does this mean that if a man has mild thinning, you can transplant hair to that region and the thinning hair will receive more blood and possibly flourish again? Or, are those cells still going to miniaturize because they have a receptor(s) for balding?

The notion that thinning hair from balding is a blood supply problem is not true. The loss of blood supply in the thinning or balding scalp is the reflection of loss of hair (not the other way around). When you get a transplant into a thinning scalp with reduced blood supply, there is an increase in the blood supply because of the demand from the new hair. It is not a chicken/egg type of thing.

The loss of the blood supply came after the hair is killed off from the genetic balding process.

Dear Doctor:

I have thin patches in my eyebrows and want them treated, preferably by means of an eyebrow transplant. Dr Rassman is one of my three short-listed doctors and I have several questions, which I would be extremely grateful if they could be answered.

Many thanks in advance

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Questions re FUE/FUT, yield etc.
1. Does the doctor recommend FUE or FUT for the eyebrow and why?

2. How does Dr Rassman avoid shock loss when implanting grafts amongst existing eyebrows?

3. How does he optimise yield of transplanted grafts?

4. What determines which follicles Dr Rassman selects for an eyebrow transplant?

5. What is unique about Dr Rassman’s approach for eyebrows as compared to similar leading transplant doctors?

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Questions re physical apperance of eyebrow

6. What is to prevent the hair turning grey later on, with age etc.?

7. How can you properly trim eyebrow hairs if they are growing horizontally?-with a simple nail scissor this would not be possible.

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Questions re preparation for operation:

8. How can you ensure the recipient area is in a healthy state to accept transplanted hairs? Should creams be used to ‘disinfect’ the area?

9. What factors would make an eyebrow transplant unsuitable for a patient?

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Side effects:

10 . Can having an eyebrow transplant affect the muscles around the brow, leading to future risk of a descending brow?

11. Is it risky operating on an eyebrow from the perspective of harming arteries etc. close to the eye? Can this harm the eyes? Have any patients experienced this?

12. In what percentage of cases, is the patient dissatisfied with his results?

13. Many of Dr Rassman’s patients travel from abroad and so can only avail themselves of an online transplant prior to the op. Upon closer inspection on the day or the day before the operation it may transpire that the patient is not a ‘good’ candidate for a transplant. Does the doctor in these cases advise against going through with a transplant? How many times this year, for example, has the doctor turned down a patient on the day or the day before an operation?

14. What controls does the doctor put in place to measure the performance of the various technicians?

15. Does the doctor, have a feedback system with a standard feedback form for post-op patients?

Now that is some due diligence! Below are the answers to your questions.

1. Either FUE or FUT will be fine. The key is to prepare one-hair grafts and put them at the correct angle, lying flat so that they do not stick up.
2. I have never seen shock loss of the existing eyebrow hair when doing an eyebrow hair transplant. The transplanted hair often fall out and then regrow in 3-5 months.
3. There is no yield problem with experienced surgeons like me. I would expect close to 100% growth from the grafts.
4. The doctor and team look for one-hair grafts and makes sure that they are trimmed correctly. If the grafts are taken by FUE, preferably one-hair grafts are removed, but it it is taken by strip surgery, then the team may have to reduce a two-hair graft into two one-hair grafts to keep the process delicate.
5. I have a great deal of experience doing eyebrow transplants, as do a handful of other experienced hair transplant surgeons.
6. Eyebrows will turn gray with age if those particular hairs are genetically programmed to turn gray, and other than dyeing them, the color is what nature gives you.
7. I would advise you to get a good set of iris scissors to trim the eyebrows, as they do grow long. Twice or three times a week may be needed to keep them the length you desire.
8. I suggest the use of Hibiclens soap for antibacterial application. As this is toxic to the eyes, it must be handled carefully with the eyes closed when applied.
9. Unrealistic expectations.
10. Not when done properly.
11. No such problems have ever been seen in my patients.
12. I do not remember any dissatisfied patient.
13. About twice a year we turn down a patient who has flown in a long distance, mostly because of unrealistic expectations.
14. Careful quality control is exercised in every case.
15. All of my patients have full 24/7 access to me (or Dr. Pak). We encourage feedback such as this post.

For more information on eyebrow transplants see:

1. Female Eyebrow Restoration After Cancer Surgery
2. Eyebrow transplant – Patient BG
3. Baldingblog search results – “eyebrow”

Do not hesitate to call my office @ 800-NEW-HAIR to setup a phone consultation with me if you’re not local.